Peer advocates supporting older people affected by cancer

Tag Archives: End of Life

Today our thanks go to Jan Dyer of Dorset Macmillan Advocacy for taking the time to share her peer advocate’s point of view:

Cancer advocacy makes a difference now, and could make so much more. Advocacy saves the NHS money and provides better quality care, it makes cancer journeys better and easier to undertake.

Yes, you’re right, it’s very difficult to prove, it can’t be easily quantified. I could give you plenty of examples, but in pounds and pence, no. But I can tell you, that over the last three years, working as a Macmillan Peer Volunteer Advocate, I have seen it for myself. Let me share some of my experiences and pose some questions……

The patients, friends and families I meet don’t always have the tools to hold their home teams together and support their structure, they are floundering in unknown territory, with no experience to draw on.

There is a presumption that every relationship is in a good place at diagnosis, and that would be great but it isn’t the reality. Some rally and rise to the challenge, but some carry baggage on this trip, which can complicate the decision process and can make the going even harder.

Realistically, how much time do our overworked medical teams have to talk to patients and support team? For some, nowhere near enough.

If communication becomes difficult between home and medical teams, who steps in, pursues and explores possible solutions to get things moving forward again? How much easier is it to deal with patients if they come prepared for appointments because they’ve had time to discuss their worries, fear, frustrations and options in an objective environment first? Sometimes patients just want to walk away from appointments having asked all the questions they wanted to, with no ‘I wished I’d asked’’ moments later, with all the confusion and frustration that brings. Let’s face it, if it’s all new, how do you know what you don’t know?

Jan

Then there are the carers who, however well meaning, may not be not equipped for the very new situation in their life. Who want to do their very best, but don’t know how to or have time to find what they need. Who supports them? Anybody can struggle when practical problems come along, meeting unfamiliar challenges in an uncharted world.

Who will have time to discuss and help them make an end of life plan? When all around you, fearing a bad outcome are urging ‘Just be positive’ and driven by a ‘if you don’t talk about it, it won’t happen’ mentality? Who tells them, ‘you don’t have to be super positive every day, its normal to have bad days’, and gives them a safe haven to express this?

The possible situations are endless, and I haven’t even got to the easier basics like ’How can I visit my husband in hospital, I don’t drive?’ ‘How can I pay my bills, when I’m not earning at the moment?’ ‘How can I get my toe nails cut?’ etc. etc….

As an advocate, I have supported real people through all of this and more. I am trained and prepared to have the conversations that people don’t necessarily want to have with loved ones, if indeed they even have anyone to have these conversations with at all.

I would like the service to be offered to every person affected by a cancer diagnosis. The decision to accept the offer is theirs, the right to change their minds, at any time, one way or another is theirs. But in not making them this offer, it is in fact depriving people of a real opportunity. Advocacy offers each individual who is on an ‘unasked for journey through the unknown’ to have a ‘tailor made’ experience and to regain some feeling of control – which could completely change things for them – and in fact for everyone involved.

As an advocate, I have a few frustrations, but my primary one is clear; I don’t understand why an advocate is not offered to everyone.

Kath Curley of Cancer, Older People and Advocacy delivery partner Beth Johnson Foundation and Staffs & Wolves Cancer Advocacy and Support Project Manager shares a post recently published on their own project blog. She tells us about her attendance at a recent conference marking Dying Matters Week:

Dying Matters Week in Staffordshire was celebrated by a Palliative and End of Life Conference organised by University Hospitals of North Midlands on Thursday 11th May. The Conference was entitled “I didn’t want that: Why patients’ wishes matter” and was attended by over 250 delegates from across the Midlands. BJF had a stand to promote the dementia and cancer advocacy projects and was therefore able to join the Conference.

The conference was packed

There were some eminent speakers including Dr Sara Russell, Head of Research and Clinical Innovation at Hospice UK, who showed a very thought provoking film from ZdoggMD; “Ain’t the way to die” which you can find here

Sara’s message was that professionals should be asking “What matters to you?” rather than “What’s the matter with you?”

Amanda Cheesley, Professional Lead Long Term Conditions and End of Life Care with the Royal College of Nursing followed on and very much reiterated Sarah’s messages. She opened by talking about the “essence” of the person – who we are, what we are – doesn’t go away when someone dies or is dying. We should look at what is important to people emotionally, physically and spiritually.

Jan Cooper, Regional Liaison Advisor at the General Medical Council discussed the End of Life/ Palliative Care Guidance. Decision making should be a partnership and this will require a change of culture. At one time professionals made the decisions, then it swung to patients making the decision but it should be co-production – joint decision after listening, discussing and sharing information.

After lunch there were two more “professionals “ presentations from Claire Henry – the Chief Executive Officer of the National Council for Palliative Care and Dr Katherine Bristowe , a post-doctoral researcher at the Cicely Saunders Institute, Kings College, London. She has a particular interest in widening access to palliative care, and recently worked on the ACCESSCare project (funded by Marie Curie), a national qualitative interview study of LGBT people facing advanced illness and bereavement.

At this Conference the best was most definitely left until the end. The Conference closed with a presentation from Tommy Whitelaw, Project Engagement Lead for Dementia Carer Voices. He was a carer for his late mother Joan for 5 years as she had vascular dementia. He told us about his beautiful mother, Joan Whitelaw, NOT the disruptive lady in bed 6! He talked about his experiences with health professionals during his time as a carer and the importance of reassuring carers that they are doing a wonderful job.

Tommy travels across Scotland to raise awareness of the impact of dementia on families and the importance of empowering carers to carry out their difficult but vital role. Lessons to be learnt for people caring for someone with any terminal condition. There was not a dry eye in the Conference!

Joe Potts, Macmillan End of Life Care Facilitator, University Hospitals of North Midlands is to be congratulated on a stimulating, thought provoking conference – a job really well done.

Last September, Helen Vernon, advocate from Sefton Pensioners’ Advocacy Centre, wrote a blog post telling us about Peter (not his real name). Helen provided Peter with the advocacy support that meant so much to him. You can find the first part of Peter’s story here. Today, we find out what happened next…

When I first met Peter, he told me he had terminal lung cancer and he had 12 months to live. He contacted us because there were some issues with his accommodation and he wanted to resolve them with the housing association rather than waste his time moving, as mentioned in my earlier blog post. He was very happy with the advocacy support and so a few months later when he was having health problems he contacted me again.

Peter asked me to accompany him to an appointment, which I agreed to do. Unfortunately, his health deteriorated suddenly after Christmas and the planned surgery was cancelled. He obviously felt a sense that he needed to put things in order so he asked me to write a will for him. As an individual can write his or her own will, it was agreed within the team that I could do this for him. I explained to Peter that I was not giving legal advice but simply documenting his wishes and having them witnessed. In fact, there was very little to leave and it will be used to pay for his funeral.

Peter was admitted to hospital then a hospice, discharged home and readmitted. At each visit, I could see he was becoming frailer. One of his relatives lived abroad and I kept her up to date with his condition at his request. Before the final admission to the hospice, he spoke to me about wishing to go to a nursing home, as it was important to him to have his own television in the room and he felt the hospice was a dark place. I agreed to visit him after the weekend and prior to this visit, I researched the availability of nursing beds in the area. I arrived at the hospice and spoke to the nurse about his condition. She told me to be prepared as Peter was not in the same condition as when I had seen him on the Friday. She was right, he had deteriorated even further and his usual spark had faded.

Over the past three years I have worked with lots of service users who have been given this diagnosis and sadly, I have closed several cases because the person has passed away. However, for one reason or another this has been the first time I have had cause to visit someone in his or her final days in the hospice. Perhaps because this gentleman’s family all live abroad and so he did not have the same support networks, it was even more important that advocacy was there for him. I spoke to the nursing staff earlier this week and his relative was on her way to be with him.

He once told me “advocacy gave me a lot of hope that things would improve and they did improve” and “advocacy kept me going”. I hope in many small ways we have helped him along his journey.

Peter’s niece called me this morning to tell me that he sadly passed away on Saturday morning with his family at his side.

Helen Vernon, Sefton Pensioners’ Advocacy Centre

(Our thanks to Helen for this moving account of Peter’s end of life story and the obvious impact on Helen herself, Marie, OPAAL)

Charlie’s story (as told by Karen his advocate with input from Pat, his wife)

Charlie was referred to the advocacy service by the Macmillan Benefits Advisor. He’d been a hospital inpatient for 9 months as he was still being fed through a PEG (a line straight into his stomach) after radiotherapy to treat throat cancer. He hadn’t been able to return home as an appropriate Care Package had failed to be put in place. Although he was free to leave during the day, he had to spend the night on the ward while the liquid feed was slowly fed into his stomach.

Charlie believed that the radiotherapy had ‘burned a hole in his throat’ and he had wanted to pursue a complaint about this but in fact this turned out not to be the case. Working with Karen his advocate he was able to understand better what was happening and why he was experiencing the symptoms he had. Charlie was also understandably really fed up at being stuck in hospital and wanted to get back to living as independent a life as possible.

Charlie and Pat

Charlie had a long history of alcohol abuse although he had long periods of sobriety. Throughout his adult life, during his more functional periods he had sustained a relationship with Pat and after his diagnosis she was there to support him. Unfortunately, prior to his diagnosis Charlie had been drinking heavily and found himself in a vulnerable situation where his flat was frequented by (often unwelcome) visitors and neither the location nor the condition of the flat meant it was a suitable place to be discharged to and for nursing staff to attend.

Due to his alcohol use, Charlie’s memory was very poor and when he was drinking he had been exploited financially by some individuals in his life. As a result a Power of Attorney was lodged with the local authority and his finances were controlled by a Deputy there.

Pat was keen to support Charlie and Karen his advocate quickly got to know them both. Together they were struggling to get things in place to facilitate Charlie’s discharge. Pat’s flat was too small to accommodate the medical equipment and visiting medical staff that this would entail and she understandably felt unable to take on the medical aspects of his care.

Pat describes Charlie at the point when he was first introduced to Karen, “He got very depressed. They kept saying they’d release him from the hospital, but it didn’t happen. They couldn’t sort out his care at home, so they couldn’t work out how to discharge him. He couldn’t eat, but he could drink alright. He told me he’d had enough.”

Charlie’s future was far from certain when Karen first met him, he’d had radiotherapy to treat his throat cancer but there was no definitive prognosis. Karen attended appointments with him and his partner (and latterly wife) Pat.

Karen supported Charlie at appointments, reminding him, ensuring hospital transport was in place and liaising as requested with health care professionals to ensure that he understood what was happening. She ensured he was supported to return to being able to eat some foods as soon as possible rather than taking all his nutrition via the PEG.

Once Charlie’s diagnosis became terminal, the focus of the advocacy centred on supporting him to stay in control of his life right to the end. Charlie desperately wanted to leave hospital and Pat and Charlie wanted to finally get married. The advocate was able to represent Charlie to both the Deputy administrating the Power of Attorney and his Social Worker to facilitate not only these wishes but also his wish to die at home.

Karen helped Charlie and Pat get appropriately graded on the housing list and successfully bid on a two bedroomed bungalow. When relations broke down with the Social Worker Karen negotiated on Charlie’s behalf so that he no longer had to deal with the individual who had made him feel very judged and misunderstood. When relations also broke down with the appointed Deputy all negotiations were carried out by Karen which alleviated some of the stress for Pat and Charlie.

Karen’s challenge to the attitudes Charlie encountered from some health and social care professionals meant that his wishes were respected and that, in spite of them not necessarily understanding his decisions, they were respected.

Karen and Pat

Charlie’s cancer returned shortly after he had begun to slowly eat solid food again and he was faced with a terminal diagnosis. Sadly, he passed away in December 2015.

Charlie’s wife Pat says, “Our advocate, Karen, helped with such a lot. She used to speak up to the County Council for me, because I didn’t want to get into another argument. She helped Charlie to get to his hospital appointments on time. She’d meet him in Poole to make sure he arrived. I’d have been lost if it wasn’t for Karen.”

You can read more stories about the power of independent advocacy support for older people affected by cancer in Facing Cancer Together which can be accessed and downloaded here

Watch our for our forthcoming publication of volunteer stories. It’s called Time: Our Gift To You. It’ll be available to read and download very soon.

In today’s blog we celebrate a wedding, courtesy of Angela Jones, advocate with Cancer, Older People and Advocacy programme partner, Age Connects Cardiff and the Vale:

Mr Davies and Mrs Geasley are a couple who have been receiving some support from the Cancer, Older People and Advocacy team in relation to organising their finances, as sadly Mr Davies has terminal prostate cancer and his affairs needed sorting out to safeguard his partner’s future.

We were delighted as part of the support we provided, to be able to assist in the organising of their wedding! A first for the Cardiff & Vale Cancer, Older People and Advocacy project!

A truly lovely day where family and friends were able to spend a joyous afternoon helping the newlyweds Mr & Mrs Davies to celebrate their marriage and enjoy some quality time together, whilst he was receiving treatment in a local hospice. Marie Curie Hospice were marvelous in facilitating the wedding and even the press were on hand to highlight the couple’s happiness.

An afternoon that meant so much to many people, and helped secure some happy memories, and as part of the Cancer, Older People and Advocacy project I am privileged to have been allowed to also have been part of the organising of this special event.

Hello my name is Rod and I have recovered from cancer. I was diagnosed with testicular cancer. It was a bit of a surprise but when my wife told me that my left testicle felt like a walnut I thought I’d better get this checked out.

I had surgery to remove the testicle, a very quick operation by the way, and it only took a day before I was walking around again. What I found most difficult to deal with was waiting to find out, I found that more difficult than the treatment. I eventually went to see the consultant and he informed me that the testicle was cancerous and that I would have to undergo a course of treatment. The treatment made me feel sick all of the time and after the first session I got back home and threw up! They prescribed me a course of anti sickness tablets but they made it worse! In all honesty I wasn’t scared about having cancer, my friends were more worried than I was. Don’t get me wrong I wasn’t happy about having cancer, but I couldn’t change it, I just had to live with it.

Just because you have cancer doesn’t mean that how you live your life has to end. Friends tried to wrap me up in cotton wool and protect me. I was a bit physically limited in what I could do (feeling weak all the time) but I wouldn’t let it stop me from going out and enjoying myself.

The consultant said that is was possible that the cancer could spread through my lymphatic system so the course of treatment was shortish but aggressive. What surprised me the most was still being able to have a physical relationship with my wife, which resulted in the birth of our twins, one of each, I was dead chuffed.

A while later I thought something was wrong again, as I was having constant diarrhoea. Consequently I had a endoscopy, which found nothing, and then a colonoscopy, where various polyps were removed. When I next saw the consultant he informed me that they were in the early stages of change. This time I was a bit worried, as this is what my father had died from. As it turns out I was fortunate, as this was caught early and very recently I received the all clear.

Rod

My volunteering

I am currently unemployed and signed off until April 2017. As a consequence I have plenty of time to spare. I was looking through the doit.org website and came across the peer advocate position, with Sefton Pensioners Advocacy. Certainly when my father was diagnosed with cancer there seemed little or no help or support, which really hadn’t changed that much when I was diagnosed. I felt that through my own cancer journey and other members of my family I had something to offer in terms of support and guidance.

I have had two clients so far and they have very different stories. Although they are my clients I prefer to just think of them as people that I am supporting. They have both been unique, facing different issues and challenges. One client has already recovered from one form of cancer, only to find out that she has another. There are other complications as well, mostly to do with chronic pain, which she is having treatment for. The main issue this lady has is with mobility, as she had no blue badge she found it difficult to get around as she was limited to where she could park. I successfully applied for her blue badge, which has completely changed things for her, she can now drive to the local village and park outside the supermarket to do her shopping. She is really, really pleased with this as it has given her a greater sense of freedom. Her details were forwarded to the DWP and now she and her husband both receive attendance allowance. Now they can afford to have the house cleaned and garden maintained, which is very important to them both.

My second client has been completely different. He was diagnosed with lung cancer, which had spread to his brain and his diagnosis was terminal. His eyesight was also failing. His behaviour was challenging at times but a lot of this was sheer and utter frustration at not being able to express himself fully. I first visited him in hospital, with a colleague, and his behaviour was challenging. To be fair he had been in hospital for the best part of a month. Eventually he was discharged and he returned home and I was able to support him in terms of getting there, making sure a hospital bed was installed (he had been sleeping on the floor) and ensuring food was delivered (thank you Foodbank). However this only lasted one night and he was then readmitted to hospital. He was then reassessed and admitted to a nursing home. He was much happier with this as he had the space of the whole lower ground floor and a greater sense of freedom. I was able to support him in terms of getting more clothes and taking him to his property, to help him sort through his important documents and things.

He was initially worried about his funeral and also getting in contact with his estranged daughter. On investigation it became apparent that he already had a funeral plan. I helped him to make contact with his daughter again and also arranged for him to have regular communion. During the days before his death he deteriorated drastically, not communicating at all. As he was on morphine every three hours this was hardly surprising. Although I knew he had terminal cancer I still found it a shock when his nursing home informed me that he had died at 6:30am that morning. There were things that I still wanted to guide him with. I have an immense feeling of frustration that I was not able to help as much as I could, but sometimes things just work out that way. The final thing I could do for him was to make sure his daughter was aware of his final wishes and thus I made sure to communicate these to her.

I attended his funeral to pay my last respects.

Advocacy for me so far has been, challenging, frustrating but ultimately rewarding and will continue to be so.

It is a sad truth that the people we support at Dorset Macmillan Advocacy have been diagnosed with cancer or are caring for their loved one who have cancer. It is not unusual then that we come into contact with people who have experienced a great deal of loss in their lives or may experience loss during the course of the advocacy partnership. We, as advocates, often find that we are supporting people though some of the most difficult times in their lives and so it is not surprising therefore that we find ourselves personally affected by their circumstances. This is particularly true of our Macmillan Advocates as they themselves have had experience of cancer, and so are likely to recognise parallels at times, with those people they support. As well as supporting people who are bereaved we too experience loss in our roles as advocates and can sometimes be so focused on supporting others that we do not recognise the loss that we experience ourselves.

One of the coordinators on our Macmillan advocacy project felt that inviting volunteers at Dorset Advocacy to come together and share their experiences and feelings on the subject of bereavement might help us to recognise these emotionally difficult times and use them to identify ways of protecting and looking after ourselves.

Initially it was thought that this would be specifically for Dorset Macmillan peer advocates, but through the course of discussions about the training we found that the issues raised were likely to affect all of those volunteers who support vulnerable people across the county and that paid advocates too could benefit greatly from this training, so we decided that it should be opened up a wider group at Dorset Advocacy.

Kate Woodhouse (trained bereavement counsellor) facilitated this training on a sweltering hot summer’s day in late July and a dozen or so of us crammed in to the sauna that was Dorset Advocacy’s training room. There was a mixture of advocates from our volunteer base and paid advocates, all of whom work/volunteer for Dorset Advocacy projects. We spent some time chatting over lunch and sharing ideas and experiences before we reorganised ourselves and sat in a circle. This was a no-barriers style training and so we were not behind tables with note pads: we were sitting opposite our colleagues, ready to listen and to share. Kate ensured that we felt safe within this space and asked us to be considerate and respectful to those who spoke as well as those who chose not to.

Despite the heat it felt as though those who attended were comfortable enough to explore the sensitive subject of bereavement/loss and what it meant to them. We took turns to choose and present objects that represented our own experiences of loss. Many individuals in the group used these objects as a means through which to explain a loss they had experienced and reflect upon it.

We were also encouraged to relate personal experiences, worries, anxieties and difficulties to marbles and add them to a jug of water prompting us to consider how we as people can only cope with so much before we run out of capacity. We explored ways that we, as individuals, can look after and protect ourselves alongside offering support to others so as to ensure that we are in a position to give support.

What this training highlighted to me was the importance of having a free and safe space to enable advocates to speak honestly and openly about their experiences. All of the people at the training had different experiences and had been affected differently by them. We must remember this and ensure that those people who are offering support and sharing the weight of worries and emotions with others are, in turn, able to share theirs and are encouraged to take time and recognise when to focus attentions on themselves.

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We've published "Every Step of the Way": 13 stories illustrating the difference that independent advocacy makes to older people affected by cancer and "Facing Cancer Together": demonstrating the power of independent advocacy.

You can find and download pdf's via the "About Us" page. You can click on "About Us" on the top right of this page. Alternatively you can order hard copies free from Macmillan Cancer Support by following the same link as above.

We've now also published "Time: our gift to you", 19 volunteers' stories from some of our peer advocates and cancer champions. It can also be downloaded via the "About Us" page on the top right of this page.